Provider Demographics
NPI:1831219617
Name:WOLNY, LIDIA KRYSTYNA (DC)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:KRYSTYNA
Last Name:WOLNY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MCKEEVER AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-889-1432
Mailing Address - Fax:510-889-1448
Practice Address - Street 1:1012 MCKEEVER AVENUE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-889-1432
Practice Address - Fax:510-889-1448
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05623Medicare UPIN
DC0150740Medicare ID - Type Unspecified